Magnetic Resonance Enterography Predicts Long‐Term Outcomes in Crohn's Disease: A Systematic Review and Meta‐Analysis

ABSTRACT Background and Aims Crohn's disease (CD) is characterized by chronic transmural inflammation, which often leads to bowel damage. While mucosal healing (MH) is an established treatment target, transmural healing (TH) has emerged as a more comprehensive goal. Magnetic resonance enterography (MRE) provides excellent soft‐tissue resolution for assessing TH. This meta‐analysis evaluates the prognostic value of MRE in predicting surgery, hospitalization, and treatment escalation in adults with CD. Methods A total of 16 studies involving adult CD patients with ≥ 12 months of follow‐up (with a mean duration of 4.42 ± 3.90 years) were included if they incorporated pre‐ and posttreatment MRE, reported baseline MRE phenotypes (e.g., penetrating/stenosing lesions), and documented posttreatment TH. Hazard ratios (HRs) were used to compare associations between baseline MRE features, TH achievement, and long‐term outcomes. Results Baseline MRE‐defined penetrating lesions were associated with increased risks of surgery (HR = 1.62, 95% CI: 1.37–1.91, p  < 0.00001) and hospitalization (HR = 1.34, 95% CI: 1.18–1.53, p  < 0.0001). Similarly, stricturing lesions were associated with an elevated risk of surgery (HR = 1.65, 95% CI: 1.39–1.96, p  < 0.00001). Achieving TH was linked to lower risks of surgery (HR = 0.55, 95% CI: 0.44–0.68, p  < 0.00001), hospitalization (HR = 0.54, 95% CI: 0.45–0.64, p  < 0.00001), and treatment escalation (HR = 0.51, 95% CI: 0.46–0.57, p  < 0.00001). Notably, TH achieved significantly greater risk reduction than MH alone, as evidenced by two direct comparative studies of these two treatment targets (HR = 0.28 and 0.26, respectively). Conclusion MRE‐identified penetrating/stenosing lesions at baseline predict higher risks of surgery and hospitalization. Conversely, TH achievement was associated with a marked reduction in adverse outcomes. Incorporating MRE into CD management facilitates early identification of high‐risk patients for timely treatment intensification, thereby supporting personalized therapeutic strategies.